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Abstract

Introduction: In the presence of sepsis-related cardiac dysfunction, conventional echocardiography may not detect subtle cardiac dysfunction. Two-dimensional left ventricular (LV) global peak systolic longitudinal strain (GLS) can detect early cardiac dysfunction. We sought to determine the prognostic value of GLS for patients with septic shock who were admitted to intensive care units (ICUs).

Methods: We prospectively included 111 patients who were admitted to the ICU with septic shock. A full medical history was recorded for each patient, and LV systolic function, including GLS, was measured. Our endpoints were ICU and in-hospital mortality.

Results: The ICU and hospital mortalities were 31.5% and 35.1%, respectively. There was no significant difference in LV ejection fraction of the non-survivors and the survivors; however, upon ICU admission, the non-survivors exhibited GLSs that were less negative than those of the survivors (non-survivors vs. survivors: -11.8±4.5% vs. -15.0±3.6%, p <0.001), which indicated worse LV systolic function. The patients with GLS ≥-13% exhibited higher ICU and in-hospital mortality rates (hazard ratio: 4.34, p <0.001 and hazard ratio: 4.21, p <0.001, respectively). Cox regression analyses revealed that higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores and less negative GLS were independent predictors of ICU and in-hospital mortalities. GLS was found to add prognostic information to the APACHE II score.

Conclusions: These findings suggest that combining GLS and the APACHE II score has additive value in the prediction of ICU and in-hospital mortalities and that GLS may be helpful in the early identification of high-risk septic shock patients in the ICU.